Qs one-liners

Gynaecology
● Urinary frequency and urgency and painful voiding + dyschezia + dysmenorrhoea + sacral backache with
menses + deep dyspareunia ⇒ endometriosis
○ Ectopic endometrium in the pouch of douglas / rectovaginal septum ⇒ dyschezia
● Progesterone is the hormone to confirm ovulation
○ Infertile woman → test to assess ovulation? Mid-luteal progesterone (7 days before the expected next
period) → if low → repeat

● Urinary incontinence
○ Stress incontinence = on sneezing / coughing
■ Treatment in order: (1) Conservative: Pelvic floor exercises 8 reps 3 sets a day for 3 months
(2) Surgical: Retropubic mid-urethral tape (tension-free vaginal tape)
(3) Duloxetine
○ Urge incontinence
■ Treatment in order = (1) Behavioural modification: Bladder retraining for 6 weeks
Minimum; modifying fluid intake, avoiding caffeine and alcohol
(2) Antimuscarinics: oxybutynin, tolterodine, darifenacin
(don’t give immediate-release oxybutynin to frail old women)
○ Ring pessary is for cystocele

● PCOS
○ PCOS clinical picture → do ultrasound pelvis → 12+ follicles on the ovaries can help make the diagnosis
○ LH is very high ⇒ LH:FSH ratio is > 2
○ Management: depends on what you’re trying to fix (and on the complaint in the vignette).
■ Menstrual irregularities? Weight loss + contraceptives (COCP/cyclical progestogen/IUS)
■ Infertility? Weight loss + clomifene citrate
If clomifene fails → +metformin or +gonadotropins or +laparoscopic ovarian drilling

● Gynae ethics
● Suspected femal genital mutilation (FGM) + >18 years old → initiate safeguarding procedures
● Suspected femal genital mutilation (FGM) + <18 years old → report to the police
● African patient + bloating + heavy regular periods + big uterus size ⇒ fibroids
● A woman with ovarian torsion is with the gensurg team ⇒ call the gynaecology on call, do NOT take her to
theatre :)))) even if she’s dying
● Young woman with acute pelvic pain in A&E → transvaginal ultrasound (diagnose PID and r/o ovarian cyst or
adnexal torsion)

● Vulvar pathologies
○ Lichen sclerosus ⇒ vulvar itching that is worst at night + white atrophic plaques + dyspareunia ⇒ treat
with topical steroids ⇒ follow-up at 3 and 6 months to ensure response to treatment
■ No follow-up ⇒ 4% incidence of malignant change to squamous cell carcinoma of the vulva
 Qs one-liners
Oncology
● Ovarian cancer
○ 50+ years old woman + vague abdominal symptoms
■ + no abnormal masses palpable ⇒ request CA-125
■ + ascites on examination ⇒ urgent referral to gynae
■ pelvic/abdominal mass on exam ⇒ urgent referral to gynae
○ 50+ years old woman + vague abdominal symptoms + raised CA-125 ⇒ refer for an urgent ultrasound
○ 50+ years old woman + vague abdominal symptoms + raised CA-125 + ultrasound positive for Ovarian
cancer ⇒ urgent referral to gynae

● Endometrial hyperplasia
○ EH is premalignant and can lead to endometrial carcinoma. It is caused by excess unopposed oestrogen.
○ Investigations: TVUS (to check for endometrial thickness) → if ≥4mm → confirm with endometrial
sampling / formal endometrial curettage by doing hysteroscopy and biopsy
○ Management
■ EH without atypia → IUS (first-line) or continuous oral progestogen

● Cervical cancer
○ Guideline picture on the right shows the new way (that is doing HR-HPV
before cytology)
○ The old way is liquid cytology and we start with it, and move on depending
on the result (pap smear = cervical cytology)
■ Negative/normal cytology ⇒ routine recall (same as new)
■ Inflammatory only ⇒ repeat swab in 6 months
■ Severe inflammation only ⇒ take swabs for infection
■ Inadequate cytology ⇒ repeat sample
■ Inadequate after repeating ⇒ colposcopy
■ Borderline cytology ⇒ HPV test
■ Mild dyskaryosis ⇒ HPV test
■ Borderline and HPV+ ⇒ colposcopy
■ Mild dyskaryosis and HPV+ ⇒ colposcopy
■ Mild dyskaryosis and HPV testing not available or inadequate ⇒ colposcopy
■ Mod/severe dyskaryosis ⇒ urgent colposcopy (2-week wait)
■ Suspected invasion ⇒ urgent colposcopy (2-week wait)
■ Abnormal glandular cells ⇒ urgent colposcopy (2-week wait)
○ Abnormal bleeding (even if brown discharge) that persists for more than 6-8 weeks + normal cervical
smear + normal cervix on speculum exam + swabs are negative ⇒ refer to colposcopy (i don’t understand
why, check question GY2042)

● Meigs’ syndrome (AKA Demons-Meigs syndrome)

○ Key features: benign ovarian tumour + ascites + pleural effusion
○ Other possible symptoms in the stem ⇒ pelvic pain, exudative pleural effusion (Light’s Criteria)
○ Example: 49F + SOB for 3 months + abdominal pain + bloating + fatigue + pelvic pain + dullness to
percussion in one of the lung bases + decreased breath sounds on the same area + abdominal fullness and
shifting dullness on abdominal exam + thoracentesis reveals exudative pleural effusion ⇒ think Meigs
 Qs one-liners
Infections
● Pelvic inflammatory disease

○ Best next step:

■ Young woman (<25) + dysuria + dyspareunia + vaginal discharge + negative urine HCG
⇒ think PID ⇒ most appropriate next step ⇒ take an endocervical swab
■ Young woman + Hx of PID + fever + rigid abdomen + cervical motion tenderness ⇒ do TVUS
■ The difference is that in the second vignette we are suspecting a complication of PID that is
tubo-ovarian abscess or pelvic abscess. A high vaginal swab / endocervical takes days.

○ Management of PID:
■ Outpatient management: ceftriaxone 500 > doxymetro 500
● Ceftriaxone single-dose IM 500mg
↓ followed by ↓
● Doxycycline BID oral 100mg for 14 days
+ Metronidazole BID oral 400mg for 14 days
■ Inpatient management: ceftriaxone 2g > doxymetro 500
● Ceftriaxone IV daily 2 grams for 14 days
+ doxycycline BID oral 100mg for 14 days
+ metronidazole BID oral 400mg for 14 days
■ Do not wait for swab results before commencing antibiotics
■ If you had to change after results, probabs the switch will be to ofloxacin, as gonorrhoea is getting
resistant to fluoroquinolones
 Qs one-liners
● Tubo-ovarian abscess is a complication of PID
○ On ultrasound ⇒ multilocular complex adnexal mass with debris, septations, and irregular thick walls
● C-section + Postpartum fever + foul-smelling discharge + empty endometrial cavity on ultrasound + placenta
and membranes were examined to be complete intraoperatively = endometritis
○ Management: any of the following combinations
■ Co-amoxiclav (augmentin)
■ Gentamicin + clindamycin (gentaclinda)
■ Gentamicin + cefotaxime + metronidazole (genta + cefometro)

● Vaginal infections
○ Swabs

○ Fish / foul smell + grey discharge = bacterial vaginosis = gardnerella vaginalis = >4.5 = metro
○ Foul smell + Green-yellow discharge = trichomonas vaginalis = >4.5 = metro
○ Candida <4.5 (acidic)
 Qs one-liners
Contraception
● Choosing contraceptives
dysmenorrhea menorrhagia irregularity contraception VTE risk other
IUS (Mirena) ✔ ✔ ✔
Copper IUD ✘ ✔ None
COCP ✔ ✔ ✔ ✔ ↑ ✘ migraine with aura
POPs ✔ ✔ Breastfeeding
Depo-provera injectable ✔ IM in sickle cell disease
Etonogestrel implants ✔
Tranexamic acid ✔ ✔ ✘ ✘
Mefenamic acid ✔ ✔ ✘ ✘

Desired duration
IUS (Mirena) 5 years
Copper IUD years
Depo-provera injectable 3 months
Etonogestrel implants 3 years
COCP 6+ weeks

○ Intrauterine Contraceptive Device = IUCD = Intrauterine Device = IUD

○ Mirena = Intrauterine System = IUS levonorgestrel-releasing IUD
○ POPs = progestogen-only pill
○ DMPA = depot medroxyprogesterone acetate = progestogen-only injectable = POI = Depo-provera
○ Nexplanon = etonogestrel implant

○ IUDs / implants >> if wants contraception for few years

○ Depo-provera >> fertility starts 8-10 months after the last dose
○ POPs / COCP >> best if needs short-term contraception

○ Most effective contraceptives in order: Nexplanon > IUS > tubal ligation

○ IUCDs and uterine morphology

■ Fibroids do not distort the cavity, you can use IUCD
■ “Palpable irregular shaped uterus”, you can’t use IUCD

○ Migraine with aura

■ COCP is absolutely contraindicated (UKMEC 4)
■ Mirena (levonorgestrel-releasing IUD) is UKMEC 2
■ POPs and DMPA and progestogen-only implant can be used (UKMEC 2)
■ Copper IUD is the safest (UKMEC 1)
■ Progestogen-only pill is safe in migraine with aura
 Qs one-liners

○ Menorrhagia > IUS is first line

■ Even if menorrhagia ONLY and asexual and no other signs and symptoms >> IUS still!
■ What if she wants to conceive? > consider tranexamic acid or mefenamic acid
■ What if we can’t use IUS + she wants contraception? > consider COCP or cyclical oral progestogen
■ <20 years old + menorrhagia + dysmenorrhea + asexual + irregular menses ⇒ COCP
■ Dysmenorrhoea + menorrhagia + wants contraception ⇒ intrauterine system (first-line)
■ Dysmenorrhoea + menorrhagia + fibroids ⇒ intrauterine system (fibroids don’t distort the cavity)
■ Menorrhagia if she is <20 years old + wants contraception ⇒ don’t give IUS, give COCP or POP
■ Menorrhagia if she has sickle cell disease + wants contraception ⇒ depo-provera IM
○ If she has PMS + wants contraception >> COCP
○ Personal history of VTE + no menorrhagia >> intrauterine copper device
○ Personal history of VTE + menorrhagia >> Mirena coil (IUS)
○ Distorted uterine cavity + needs longest safest contraception >> nexplanon
○ Mefenamic acid helps pain and helps reduce menstrual loss but doesn’t regulate menstrual cycles
○ Risk of pregnancy after sterilisation by tubal ligation → 1:200 (1 woman in 200 women)

○ Teratogenicity, enzyme-inducers, & contraception

If patient is on → Enzyme-inducers teratogens

(CRAP GPs)
IUS (Mirena) Not affected best option
Copper IUD Not affected effective
Depo-provera injectable Not affected combine with +condom
Etonogestrel implants affected effective
Emergency contraception affected use copper IUD
COCP affected
POPs affected

■ Basics
● You want highly effective contraception for a patient who needs to be on a teratogenic drug.
Common teratogenic drugs: MTX, sodium valproate, retinoids, warfarin
Highly-effective contraception: Copper IUD, IUS, depo-provera+condom combo
● Enzyme inducers can decrease the efficacy of contraceptives.
Enzyme-inducers: CRAP GPs:
Carbamazepine, Rifampicin (& Ritonavir), chronic Alcohol use, Phenytoin, Griseofulvin,
Phenobarbital, Sulfonylureas, & St john’s wort
Affected contraceptives: COCPs, POPs, implants, emergency contraceptives
■ Scenarios
● Taking enzyme inducers + non-teratogens → use IUD / IUS / depo provera
● Taking enzyme inducers + teratogens → use IUD / IUS / depo provera + condom combo
● Taking non-enzyme-inducers + teratogens → use IUD / IUS / SDI
● Taking enzyme inducers or teratogen and needs emergency contraception → copper IUD
 Qs one-liners

● COCPs and POPs schedule

○ Missed COCP (ethinylestradiol 30-35 micrograms)

■ Any missed COCP (whether 1 or 2 or more) ⇒ take the last pill ASAP even if it means taking 2 per day
■ The question is: what else to do other than taking the last pill ASAP? It depends:
● If 1 pill of COCP is missed
○ Continue with the rest of the pack as usual + No need for additional contraception
● If 2 or more pills of COCP are missed
○ Abstain from unprotected intercourse for 7 days of taking the pill regularly
○ What if she already had unprotected intercourse?
■ If the pills were missed in WK1 + had unprotected intercourse ⇒ emergency contraception
■ If the pills were missed in WK2 ⇒ no need for emergency contraception
■ If the pills were missed in WK3 ⇒ no need for emergency contraception + skip the HFI

○ Missed POP (must be taken at the same time everyday)

■ If it’s traditional POP ⇒ if it’s more than 3 hours late ⇒ take the missed pill ASAP (but don’t take 2x a
day) + continue remaining pack as usual + abstain from unprotected sex for the next 48 hours
■ If it’s Cerazette (desogestrel) ⇒ if it’s more than 12 hours late ⇒ same as above
■ If unprotected intercourse happened after the missed pill and within 48h of restarting ⇒ take
emergency contraception

● Emergency contraception
○ Within 72 hours (3 days)? Progestogen-only Levonelle pill (levonorgestrel)
○ Within 120 hours (5 days)? Copper IUCD or ellaOne pill (ulipristal acetate)
● Mirena coil inserted ⇒ first 3-6 months: irregular and heavy periods + spotting ⇒ reassure
By 1 year: infrequent bleeding or amenorrhoea
● Depo-provera ⇒ first 3-6 months: intermenstrual unscheduled bleeding
● Continuous combined HRT ⇒ first 4-6 months: irregular breakthrough bleeding or spotting ⇒ reassure
○ When to investigate and not reassure?
■ If bleeding persists beyond 6 months
 Qs one-liners
■ If it’s abnormally heavy (unlike mirena coil)
■ If it happens after a period of HRT-induced amenorrhoea

● Management of lost intrauterine device threads

○ Step by step
1. Urine pregnancy test to exclude pregnancy
2. Pelvic ultrasound to search for the IUCD
3. Still not found by ultrasound? Do abdominal x-ray
a. (if we ended up finding it in the abdomen ⇒ laparoscopy to retrieve)
○ When to pick emergency contraception? If the stem mentions that there was intercourse within 72h
(levonorgestrel) or within 5 days (ulipristal acetate and copper IUD)
 Qs one-liners
Pregnancy
Misc
● Chickenpox and pregnancy
○ If she is actively infected with chickenpox
■ Pregnant with severe signs and symptoms of chickenpox → Admit + IV acyclovir
■ Don’t refer to derma for pregnant women with chickenpox because they are dealt by GP/A&E/OB
○ If she was in contact with someone who had chickenpox
■ First question: Was she exposed?
● Chickenpox infectious period: 2 days before the rash and 5 days after the rash appears
● Chickenpox incubation period: lasts up until 21 days after exposure
● If the contact was during the infectious period of that someone, consider her expoesd (even if she
is asymptomatic, because she can be asymptomatic throughout the incubation period until day 21)
■ If she is exposed..
● First: is she immune to chickenpox?
If immunity is unknown (doubt about previous infection or no hx of chickenpox or shingles)
→ test serum for VZV IgG within 24 hours → if present, she is immune
● Give oral acyclovir to prevent chickenpox (can be started up until day 14 after exposure)
 Qs one-liners
● Viability of foetus
○ The most specific test in determining viability of a foetus..
■ In the first and second trimesters? transvaginal ultrasound
■ In the third trimester? CTG
○ The initial test to determine viability of a foetus in the first and second trimesters is transabdominal
ultrasound → then if they don’t see a heartbeat → proceed to transvaginal scan

● PV bleeding in pregnancy
○ Painless PV bleeding + vitals indicative of blood loss (↑HR ↑RR ↓BP) ⇒ placenta previa
■ Women with placenta previa shouldn’t have intercourse
■ Management of placenta previa
● First: Speculum examination
● Second: Arrange a routine ultrasound (if not already arranged) to be done at 32 weeks
● Third: Advice the patient to avoid sexual intercourse
■ 30 weeks old woman + postcoital bleeding. Management? Speculum examination (NOT advice!)
○ Painless PV bleeding + vitals normal ⇒ vasa previa (it’s foetal blood not maternal blood)
○ Painful PV bleeding + CTG abnormalities (e.g. foetal tachycardia >160 BPM) ⇒ placental abruption
○ Painful PV bleeding → most initial test → ultrasound abdomen
○ Painful PV bleeding → single best action → CTG (placental abruption would show foetal distress and
immediate delivery is needed)
○ Avoid digital vaginal examination in women with vaginal bleeding until the position of the placenta is
known with certainty. Speculum exam is alright to perform.

● Hyperemesis gravidarum
○ Can present with ketonuria 3adi
○ Management of nausea and vomiting
■ First ⇒ IV fluids
■ Second ⇒ antiemetics
● First-line ⇒ antiemetics that end with -ine ⇒ cyclizine, prochlorperazine, promethazine,
chlorpromazine, doxylamine with pyridoxine
● Second-line ⇒ metoclopramide, ondansetron, domperidone
■ Third ⇒ IV steroids
■ If all fails ⇒ consider parenteral nutrition
■ Absolute last resort ⇒ termination of a wanted pregnancy
○ Adjunct management (not acutely needed)
■ First: correct electrolyte abnormalities ⇒ If she’s hypokalaemic ⇒ Give NaCl 0.9% with KCl
■ Next: IV / oral thiamine to ↓risk of Wernicke’s d/t prolonged vomiting and dec absorption of thiamine
■ Next: Glucose if needed
■ Dalteparin (LMWH) to ↓risk of thrombosis caused by dehydration

● Ectopic pregnancy
○ Hemodynamically stable? Laparoscopic removal
○ Hemodynamically unstable? Immediate laparotomy (laparotomy is quicker than laparoscopy)

● After day 21 postpartum + not breastfeeding + PV ⇒ reassure if she is absolutely well

⇒ high vaginal / endocervical swab if she’s unwell
(suspected 2° PPH)
⇒ pelvic ultrasound if unstable or signs of infection
 Qs one-liners
● Evacuation of products of conception → histology shows hydatidiform mole → what is the most appropriate
investigation? Serum ß-HCG (expected to be extremely elevated)

● Anaemia in pregnancy
○ First trimester ⇒ <110 is anaemia. If >110, reassure (physiological haemodynamic anaemia)
○ Second and third trimesters ⇒ <105 is anaemia. If >105, reassure (physiological haemodynamic anaemia)
○ Postpartum ⇒ <100 is anaemia. If >100, reassure (physiological haemodynamic anaemia)
● Pregnant + severe abdominal pain + tenderness over previous c-section (can also be post myomectomy) +
absent uterine contractility → uterine rupture
● Never choose uterine rupture in a primigravid woman with 0 history of c-sections or myomectomies
● Cocaine increases risk of placental abruption.
○ Cocaine user + pregnant + loss of blood and abdominal pain → choose “placental abruption” but not
“placental abruption secondary to preeclampsia” because there are no features of preeclampsia in the
stem, even tho she is a cocaine user, do not assume.

● Miscarriages
○ Miscarriage = loss of pregnancy < 24 weeks gestation (time of viability)

Threatened Inevitable Incomplete Complete Missed (delayed)

Vaginal bleeding + + +/-
Foetal heart + -
Cervical os • o •
Expulsion of products Not all yet Everything expelled None

○ “Spontaneous miscarriage” is a miscarriage that is not induced, and includes all of the options above.
○ PV bleeding at 6 weeks + no foetal cardiac activity detected on TVUS → rescan in 7 days
■ Baby’s heart starts beating at 5 weeks, but can start later. Rescan to ensure this is not a miscarriage

● Rhesus negative mothers

○ A rhesus negative mother + first pregnancy (not sensitised yet) + we want to give her anti-D
immunoglobulin to prevent sensitisation ⇒ do the Kleihauer-Betke test to determine teh amount of
anti-D immunoglobulin necessary
○ A mother has anti-D antibodies in her second pregnancy + reduced foetal movements at 33 weeks + CTG
is normal ⇒ most appropriate investigation? Assess foetal middle cerebral artery on ultrasound (to allow
estimation of foetal haemoglobin concentrations and the severity of foetal anaemia) ⇒ if the peak systolic
velocity of the middle cerebral artery is abnormal ⇒ do foetal cord blood sampling to directly quantify
foetal haemoglobin concentration
○ First-time vaginal delivery in a rhesus-negative mother → administer anti-D immunoglobulins ASAP and
always within 72 hours, up to 10 days.

● Maternal tachycardia + hx of PROM + suprapubic tenderness + purulent vaginal discharge ⇒ chorioamnionitis

○ Maternal tachycardia precedes pyrexia, the stem can mention a normal temperature, don’t be fooled.
 Qs one-liners
Hypertension in pregnancy
● Anti-HTN in pregnancy: labetalol > nifedipine > methyldopa
○ Start with labetalol → if asthmatic give nifedipine → if not available give methyldopa
○ Methyldopa increase risk of postnatal depression
○ The 3 of them are ok for breastfeeding
● Terminology
○ Basic definitions
■ Hypertension? >140 SBP or >90 DBP
■ Proteinuria? 24-hour protein ≥0.3g / 24 hours (old definition)
or Protein:Creatinine ratio (PCR) ≥ 30 mg/mmol
or Albumin:Creatinine ratio (ACR) ≥ 8 mg/mmol

Other signs and

Definition / clinical presentation Management
symptoms
Chronic
HTN before 20 weeks of gestation
hypertension
Gestational New-onset HTN after 20 weeks without
hypertension significant proteinuria
Headache, flashing lights, ● First-line: oral labetalol
New-onset HTN after 20 weeks
Preeclampsia with proteinuria epigastric/RUQ pain, rapid ○ Nifedipine / hydralazine are also OK.
oedema, hyperreflexia ● Cure: deliver baby
Preeclampsia + SBP>160 or DBP>110 ● Severe HTN or severe pre-eclampsia ONLY?
Severe or preeclampsia + recurring severe Brisk reflexes are signs of Pick anti-HTN (labetalol)
preeclampsia headaches, scotomas, epigastric pain with an impending seizure ● Brisk reflexes /clonus /eclamptic fits? MgSO4
deterioration in labs (↑Cr ↑LFTs ↓platelets) ● Once pt is stable → Pick plan for delivery
HELLP Preeclampsia + Haemolysis + Elevated
syndrome Liver enzymes + Low Platelets
Acute fatty Preeclampsia + ↑ Liver enzymes + ↑ PT ↑ Treat hypoglycaemia
liver of aPTT + jaundice + ↓glucose + ↑ ammonia Nausea / Vomiting + Correct clotting disorders
abdominal pain + fever +
pregnancy headache + pruritus
NAC (unlicensed use)
(AFLP) Typically happens >wk30 or after delivery Consider early delivery
Eclampsia Preeclampsia + ≥1 seizures

● What if the patient is still seizing on MgSO4?

○ Give a further bolus of 2g MgSO4, or
○ Increase infusion rate to 1.5g or 2g per hour
● MgSO4 toxicity
○ Presentation: Confusion, loss of deep tendon reflexes, respiratory depression, hypotension
○ Management:
■ If only loss of patellar reflex → Stop MgSO4 infusion + send levels to lab urgently
or RR <10 → antidote: IV calcium gluconate 1g (10mL) over 10 minutes
→ withhold MgSO4 until patellar reflexes return or lab levels r known
■ If arresting → crash call + position in left lateral tilt position + initiate CPR
→ Stop MgSO4 + administer antidote as above
→ intubate + assisted ventilation until spontaneous respiration
→ Send MgSO4 levels ot lab urgently
 Qs one-liners
Menopause
● Amenorrhea for 12 months = menopause; irregularity is perimenopause
● Hormone replacement therapy types
○ Oestrogen-only HRT ⇒ if she had hysterectomy or IUS
○ Sequential (cyclical) combined HRT ⇒ for perimenopause
○ Continuous combined HRT ⇒ for menopausal women or women who have been on sequential for 1 year
● Perimenopausal patient on sequential HRT + regular vaginal withdrawal bleed ⇒ reassure
○ If irregular or heavy ⇒ double the dose of progestogen
● Transdermal estradiol and progestogen patches is considered HRT
● Menopausal for a very long time and now suddenly has PV bleeding → do transvaginal ultrasound to rule out
endometrial cancer by checking endometrial thickness → if the endometrium is thick → perform hysteroscopy
with endometrial biopsy
○ Most common cause of postmenopausal bleeding? Atrophic vaginitis
○ Most important pathology to rule out? Endometrial cancer
● Symptoms of atrophic vaginitis (dyspareunia, frequency, urgency, etc) without systemic symptoms >> topical
vaginal oestrogen NOT systemic HRT
● Indications for HRT Therapeutic for vasomotor symptoms post-menopause
Prophylactic for early menopause until 51 years old
After premenopausal oophorectomy until 51 years old (oestrogen-only)
● Cervical smears are done once every 5 years between ages 50-64
● Menopausal + very recurrent UTIs (5 UTIs confirmed with urine culture in the past year) + also has other
symptoms of vaginal atrophy ⇒ tx is vaginal oestrogen tablets, not antibiotic prophylaxis

Gynaecology
● Columnar epithelium is normally in the endocervix ⇒ if it migrates beyond
the cervical os ⇒ cervical ectropion
○ Post-coital and intermenstrual bleeding
○ Excessive discharge but it’s non-purulent
○ Can be caused by pregnancy or OCP use or in ovulatory phase in young
women
○ Investigation → colposcopy → red ring around the cervical os
○ Mgmt:
■ Is it caused by OCP use? Discontinue OCPs.
■ Is there no bleeding? No need to treat.
■ Otherwise burn it ⇒ cryotherapy or ablation (using silver nitrate or diathermy)